SutureSuture

Definition

A suture is a thread used for uniting wound edges

eg. Suture material Nylon, Silk Catgut, Stainless still suture

The Ideal Suture Material

Can be used in any tissue

Easy to handle Good knot security Minimal tissue reaction Adequate strength

The Ideal Suture Material Unfriendly to bacteria

Flexibility & elasticity

Won’t tear through tissues

Easily sterlisable

What’s It Used for?

To bring tissue edges together and speed wound healing (=tissue apposition)

Orthopedic surgery to help stabilize joints Repair ligaments

Ligate vessels or tissues

Characteristics of Suture Material

Absorbable Vs. Nonabsorbable

Monofilament Vs. Multifilament

Natural or Synthetic

Suture Materials

ABSORBABLE Those that are absorbed or digested by the body cells and tissue fluids in which they are embedded during and after the healing processes.

NON-ABSORBABLE: Those suture materials that can not be absorbed by the body cells or fluids.

Absorbable Sutures

Internal Intradermal/ subcuticular Rarely on skin

Non-absorbable Suture

Primarily Skin Needs to be removed later

Stainless steel = exception Can be used internally

Ligature Orthopedics

Can be left in place for long periods

Reading the Suture Label

Company

Needle

SizeOrder Code

NameAlso:

LENGTH

NEEDLE SYMBOL

COLOR

Absorbable or Non

Monofilament Vs. MULTIFILAMENT memory easy to handle less tissue drag more tissue

drag doesn’t wick wicks/ bacteria poor knot security good knot

security - tissue reaction +tissue

reaction

Natural Vs. Synthetic

Natural: Gut Chromic Gut Collagen

All are absorbable

Gut/ Chromic Gut

Made of submucosa of the ovine small intestines

Multifilament

Breaks down by phagocytosis: inflammatory reaction common

Gut/ Chromic Gut

Chromic: tanned, lasts longer, less reactive

Easy handling

Plain: 3-5 days Chromic: 10-15 days

Monofilament

Collagen

Natural suture-obtained from the bovine flexor tendon.

VERY reactive, absorbable

It is multifilament suture material.

Vicryl (Polyglactin 910)

Braided, synthetic, absorbable Stronger than gut: retains strength 3

weeks Broken down by enzymes, not

phagocytosis Break-down products inhibit bacterial

growth Can use in contaminated wounds, unlike

other multifilaments

Dexon and PGA

Polymer of glycolic acids Braided, synthetic, absorbable Broken down by enzymes Both PGA and dexon have increased

tissue drag, good knot security Both are stronger than gut

PDS (polydioxine)

Monofilament (less drag, worse knot security – lots of “memory”)

Synthetic, absorbable Very good tensile strength (better

than gut, vicryl, dexon) which lasts months

Absorbed completely by 182 days

Maxon (polyglyconate)

Monofilament- memory Synthetic Absorbable Very little tissue drag Poor knot security Very strong

NONABSORBABLE SUTURES

Natural or Synthetic Monofilament or multifilament

                           

(i)(i) SilkSilk

Obtained from the cocoon of silkworm.

This is cheap easily available easy to

handle

Easily sterilized by boiling water and

well tolerated by tissue

Silk is available in size 0-14 number.

Only disadvantage of silk is that is

capillary.

NYLON

Synthetic Mono or Multifilament Memory Very little tissue reaction Poor knot security

Polypropylene

Prolene, Surgilene Monofilament, Synthetic Won’t lose tensile strength over time Good knot security Very little tissue reaction

Stainless Steel

Monofilament Strongest ! Great knot security Difficult handling Can cut through tissues Very little tissue reaction, won’t

harbor bacteria

Suture Techniques

Some Definition UsedSome Definition Used

InversionInversion

When the edges of the incision turn inward

EversionEversion

When the edges of the incision turn outward

AppositionApposition When the edges of the incision come together

Suture patterns are divided Suture patterns are divided intointo

1.1. Interrupted PatternInterrupted Pattern2.2. Continuous PatternContinuous Pattern

Simple interrupted Simple interrupted suturesuture

Oldest and most widely used suture Commonly used, especialy when

excessive tension over entire suture line is not expected.

Point of insertion will 1 cm in bovine skin & 2-3 mm for thin skin.

Distance between two stitches is 1-1.25 cm.

If suture are applied tightly, tissues necrosis occur and infection is introduced easily.

Used in Skin, fascia, hollow viscera, vessels, nerves

Simple continuous sutureSimple continuous suture

1st stitch is similar to the interrupted pattern.

Subsequent stitches, taken at right angle to incision line without any break in the continuity of line.

Knot is tied in-between the loop & the free end together.

Used to appose the tissue that need minimum holding power.e.g.Subcutanious fascia, muscle, gastrointestinal track etc.

Interrupted horizontal Interrupted horizontal mattress suturemattress suture

• Horizontal to the line of incision.

• Tension suture used in conjuction with pieces of rubber tubing or with buttons, Result in to eversion of wound edges.

• Disadvantages:- 1. Excessive tension cause

strangulation of suture canal.

2. Due to eversion greater scar formation and delay healing

Continuous horizontal Continuous horizontal mattress suturemattress suture

Simillar to interupted horizontal mattress except the a running pattern is used.

Used on the skin, sub cut fascia, muscle etc.

Vertical mettress sutureVertical mettress suture

Suture line is perpendicular to the line of incision.

Compared with the Horizontal mattress, it allow better circulation to wound edges. So decrease the chances of necrosis.

Also used as Tension suture. Popular suture in traumatic

laceration of the skin of equine limbs, where the blood supply is compromised.

Sub cuticular sutureSub cuticular suture

To eliminate the small scar that produced around the suture holes of more common patterns.

Continuous lock stitchContinuous lock stitch

Also call for interlocking suture.

Modification of S.C.S.

More security than simple continuous suture.

Applied on skeletal muscle, diaphragm etc.

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